Tibial Plateau fracture - from a kickstarter failure

Sunday March 17th I decided to get my "new" 1947 BSA B31 started for the first time.

To cut a long story short, the kickstarter pawl slipped, I hyper-extended my knee and buggered it up somewhat.

I waited until Monday to head into the hospital, they x-rayed it and sent me home.... nothing showing on the x-ray and the surgeon I'd requested had asked them to organise an MRI. Got the MRI at 7pm Tuesday and the guy there sent me straight back to the emergency dept to get splinted up. Saw the surgeon Wed evening and he immediately scheduled me for a Thursday morning operation.

Here's a shot of the MRI

I'd knocked a 17mm round section of the tibial plateau down into the tibia by 4mm. "This is serious" said the surgeon. I had some arthritic degradation on the left side of the joint (I'm coming up on 58 in July), but the right side and centre of the joint were good.

He said my options were to let it heal by itself, but that would lead to very rapid arthritic degradation of the right side... and I'd just buggered the good centre... so that wasn't a good idea. The next option (recommended) was a stop gap repair - artificial bone graft, plate and screws. I'd still get degradation and would need a full knee replacement sooner rather than later... and the third option (not recc) was a full knee replacement now.

Come Thursday and the op was done. This was a day or so later when they whipped the drain out.

Here's the repair

Nice eh?

The leg is in a brace - locked at 30 degrees, which keeps the joint unloaded apparently. I'm in a rehabilitation hospital now, doing core and upper body exercises to improve my ability on crutches.

The leg is non-load-bearing for 6 weeks, then we see what happens from there. My guess is plenty of physio to get back the muscle wastage, etc.

I've gone from one pill a day to taking about 17 or 18.... which pisses me off. I've cut back on the opiates (Endone) to twice a day.

I did the same exact thing in 2002, Going out for the first AHRMA MX of the year, first kick, the pawl broke on my Cheney/Triumph and a split second later so did my right tibial plateau. The good news is I was almost able to keep my balance when I dropped hard onto the seat. The bad news is I lost my balance and fell over to the right.... and onto my Cheney/Ariel on its stand alongside. My wife pokes her head out the RV door and sees me buried in a pile of British Iron and folded up lawn chairs alternately swearing/moaning/groaning/whimpering. Good news is my lovely bride was traveling with me and she has first aid training so after my buddies cleared the wreckage she wrapped up my damaged appendage and kept the swelling down. Bad news is we were in Peoria Az, the western US center of geriatric medicine so instead of going to the ER and running the risk of being fitted with a colostomy bag by mistake we opted to head for home. Good news is we had a nice comfortable brand new RV with leather air ride seats for the 14 hour drive home. Bad news is our brand new RV had a 10 spd manual trans and my lovely bride didn't know how to drive a truck style trans. Good news is my left leg still worked so I could push in the clutch and we had lots of Ibuprofen and ice to keep me 'comfortable' for the 14 hour drive home.

I saw the orthopod on Mon afternoon and 24 hours later I had 7 screws and steel plate. In my case tho I woke up with my leg in a Constant Motion Machine that worked my knee joint similar to a bicycle motion. For the next week or ten days most of my waking hours were spent with my leg in the CMM and two weeks later I was in PT and sitting on an exercise bike 5 hours a week. Both the Orthopod and the PT were advocates of keeping the joint moving, and as a result I have full range of motion. Though 12 weeks of no weight bearing and crutches wasted my quads and calf. A few months of spin class 3 days a week brought back the muscle tone.

One word of advice, wear a shin guard when you're riding. You really don't want to find out what it feels like to catch roosted rocks on a plated tibia.

Sorry to see that, I have experience with knee replacements, I had a full replacement on my left knee in 2009 it wasn't much fun, but the pain relief was immediate. I needed the right done too, but put it off for 3 more years, while spending the winter in AZ I contacted a different surgeon and he advised doing a partial replacement. What a difference, I had over 130 degrees of movement back in less than a week and was driving myself to PT the next week. No "noises" from the joint when I moved it like the full replacement, an incision that was only 3 inches vs 12. When you need a new knee check out a partial, a lot of surgeons don't do them. Mine was done with the surgeons hand attached to a computer controlled robot that guided his hand. Very space age.

Thats a unicompartmental arthroplasty. Most plateau FX's are lateral, most uni's are medial, not a good mix.
Constant motion machines use to be the "next thing", but they're pretty well phased out most places now.

Two nurses to do this... well, one nurse and a student nurse observing. They were both very impressed with the quality of the wound. I take it that was a vote of confidence in the surgeon.

Now that Easter is over, I'm back on an enhanced exercise regime. Its into the wheelchair and off to the gyms twice a day now. I keep scaring the crap out of the physios, because I'm so much faster moving than the geriatrics they normally have, especially when I'm doing stairs on the crutches.... and also because I'm a lot bigger than them. They worry about me falling on them and them not being able to stop me. Believe me... I'm working on NOT falling. I'm using their heaviest weights.

Three docs called in today and were, I think, talking about me staying for 6 weeks. Um... no thanks. Home isn't too well set up for someone on crutches, but I'd go stark raving nuts here if I was in that long. Can't see any need for it... although a trip to the shower is going to be a rudie nudie trip from the bedroom to the bathroom and back. We'll see what the surgeon says next Monday.

Oh yeah... no more supplementary opiates. I'm still on the slow release Targin, but no Endone now for 48 hours. Can't see any reason to want it again. Not pain free, but not in any serious discomfort.

Unicompartmental knee replacements are far more common on the medial (closest to the midline) compartment but are done on the lateral also. Uni's are still common but not all surgeons perform them nor should. There are several factors considered whether or not a uni is an option. If there are arthritic changes in either of the other 2 compartments, you are headed for a total knee replacement. Your orthopedist can evaluate this. Most orthopedic company's websites will help you search for a surgeon that performs certain procedures. One of the more prominent uni's is the Oxford, developed in the UK 30yrs ago and distributed by Biomet, Inc. It's mobile bearing design is the only like it. Other companies offering uni's: Zimmer, Depuy, Smith & Nephew, etc. Do the research, educate yourself and good luck!

Now you'll have plenty of time to pop the cover off the gearbox and do a proper fix on the kickstart assembly. Try to get NOS BSA ratchets because some of the repros aren't of the best quality. The same gearbox was used on the military M20s, so there should be a supply available.

Now you'll have plenty of time to pop the cover off the gearbox and do a proper fix on the kickstart assembly. Try to get NOS BSA ratchets because some of the repros aren't of the best quality. The same gearbox was used on the military M20s, so there should be a supply available.

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The bike came with a lot of spares.... including new ratchets. The ones in it are supposed to be new too.... but I'm pretty damn sure they aren't.

You think the hospital would complain if I got my son to bring the box and some tools in? The bed's table would take the weight. Surely I could explain it as occupational therapy?

The bike came with a lot of spares.... including new ratchets. The ones in it are supposed to be new too.... but I'm pretty damn sure they aren't.

You think the hospital would complain if I got my son to bring the box and some tools in? The bed's table would take the weight. Surely I could explain it as occupational therapy?

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I don't know how they'd feel. Probably depends on if you could talk the nursing matron into it.

I'm an old singles guy, and I'm a bit surprised you got hurt. Done properly, you shouldn't have to kick through compression if you use the valve lifter in the right way, especially with the heavy flywheels that has. If you bring it up against compression, then hold the trigger in as you begin the swing down and release it as you get to the bottom, the flywheels will carry you through the next compression stroke without having to really push that hard.

I guess it was just me over-doing it. It didn't feel like it was getting enough momentum up.... so I eased it past compression with the lifter, then gave it a walloping great kick... and when the pawl slipped, I was hoofing 116kg of me into just my knee joint when the lever bottomed out. Snap.

Meanwhile, I got a lesson in tenderness last night. I was turning down the blanket and sheets of my hospital bed and I leaned against the rails on the side of the bed. Holy bloody mackerel (not the words I used). Brought tears to my eyes, it did. No damage though... no weeping from the wound anyhow.

That, and a small slip where I fell against the wall.... just the right sort of reminder to take it bloody easy.

Your lucky they caught it. I did a similar thing a few years back only i had more compression off the outside of the tibia. I did my first deployment on it then got back and was told it was to late to do surgery or anything. Thank god for the VA